Cultivating Resilience – a COLA Mental Health workshop

ER3aMany thanks to the College of Liberal Arts Office of Research and Graduate Studies  for hosting a broad based conversation on Resilience and Mental Health. Associate Dean Esther Raizen started the conversation by noting an increase in the number of graduate students who are seeking accommodations from the Office of Students with Disabilities.  Kelli Bradley, SSD Executive Director confirmed that thirty four percent of new applications from  over 240 graduate students cited mental health and anxiety related concerns.

This is a steep rise in graduate student request for services that have traditionally focused more on undergraduates.  Some thoughts on why graduate numbers also continue to rise at the Center for Mental Health Counseling include: fear of and the stigma of failure, financial and academic stress  and more students who have been engaged with psychological counseling.  To encourage self-care,  CMHC has launched a new iPhone app Thrive at UT. Thrive consists of seven topic areas. Topics include community, gratitude, self-compassion, mindfulness, mindset, thoughts and moods. In each topic, students will find an inspirational quote, a short video of a UT student sharing their own story, some light reading and an interactive activity.

The job market may intimidate those who already carry the burden of student loans, including grad students who may not have a tenure track trajectory. International Students face additional anxiety stemming from language insecurity, living far from home and limited access to external funding sources.  The CMHC also offers cultural adjustment resources to offset the potential for isolation, loneliness and depression.

Dr. Leonard Moore of the Division of Diversity and Community Engagement talked about the micro aggressions and feelings of being in a very small minority that students of color experience, both in their cohorts and in seeking minority mentors.  He suggested admitting students of color who can cluster in cohorts, so they do not feel so alone.  Encouraging students of color in administrative directions as well as tenure track positions would help to build a more diverse and inclusive culture in the academe and should be encouraged.

Susan Harnden, from the Employee Assistance Program recommended Susan Dweck’s Mindset, The New Psychology of Success as a resource for encouraging resilience in the face of challenges.

mindset-animation

1075722Dr. Gloria Gonzalez-Lopez has given talks on health and well being in the Sociology department, orienting incoming students as they transition into graduate school and encouraging them to find a balance between work and life. She shared tips on cultivating resilience as students face the challenges of completing their PhD.

  • learn to tolerate some suffering
  • resolve to be healthy and have a real life while working on a PhD
  • create a small network of good friends
  • get a life, don’t forsake your humanity
  • take care of yourself – sleep and eat
  • schedule fun without feeling guilty
  • have at least one supportive faculty mentor who really cares
  • become more comfortable with uncertainty – transitions are a part of life
  • keep the big picture in mind, the reason you came to make positive changes in the world
  • learn to accept a certain amount of pressure and take breaks
  • be receptive to help and advice
  • cultivate basic emotional intelligence and be honest
  • find your unique rhythm for productivity
  • remember to reach out for help if you need it
  • do not routinely overwork
  • practice compassion for yourself and others

It is getting harder to avoid the feeling that our world is in turmoil. The  tension between the old and the new can be overwhelming, particularly when uncertainty and negativity are part of the 24 hour news cycle.  Cultivating the resources we need to survive and thrive during these time of transition are not only advisable, they are necessary.  UT Austin has so many resources, for both the individual and the community, please use them and share generously.

Duty, Honor, Country, Disparity: Race/Ethnic Differences in Health among Veterans

by Connor Sheehan

A campaign supporter’s sign at a Trump rally in Chicago. (Source: Wall Street Journal)

During the 2016 election cycle, Democratic and Republican candidates for president have consistently discussed veteran health issues and reform of the Veterans Administration (VA).   The increased attention to veterans and their health is well-warranted, as veterans are an enormous population in the United States totaling over 23 million—almost as many people as live in the entire state of Texas. Veterans, of course, also have unique health, partially due to the occupational and behavioral hazards that accompany military service. As part of this policy discussion, it is important to discuss the large racial and ethnic health inequalities that exist among veterans. As I show below, racial and ethnic minority veterans consistently report worse health and have more health related limitations to activities than white veterans. These gaps are hard to ignore, particularly at a time when the veteran population is becoming increasingly racially diverse and the share of underrepresented groups among veterans is expected to increase dramatically over the next few decades (see Figure 1).

Sheehan Image 1

As a PhD student in the Sociology Department at the University of Texas, I have been conducting research that sheds some light on the extent and nature of racial and ethnic disparities in health and ultimately suggests what can be done about them. First, my findings consistently show that sizable health disparities exist. An analysis I conducted of a nationally representative survey of veterans administered by the VA showed that almost half of black veterans report “fair” or “poor” health rather than more favorable categories such as “good,” “very good,” or “excellent.” Conversely less than a quarter of whites reported “fair” or “poor” health (See Figure Two) (Sheehan et al 2015). The analysis also showed that 13% of black veterans report a severe activity limitation such as not being able to walk, get dressed, use a toilet, or eat. In contrast, less than 5% of white veterans reported having such limitations.

Not only are black veterans lives characterized by worse self-rated health, and more activity limitations, they are also shorter. In my own (unpublished) analysis using the Linked Mortality File of the National Health Interview Survey, I found that, even after controlling for age and region of residence, Black veterans were 43% more likely to die compared to white veterans from 1997-2011 (see Figure 2).

Sheehan Image 2

Imagine, so many of these veterans who once dedicated their lives to our country and sacrificed so much, are in such poor health. The American public and the presidential candidates cannot stand by and do nothing. The military, a longstanding institution that requires its members to uphold values like discipline, integrity, and loyalty should now uphold the same and do right by them. The VA, which shares similar values to the military and which also strives to provide equitable services, can also help minimize disparities.

There is a lot that can be done to reduce racial disparities in health among veterans. Any effort aimed at minimizing health disparities in later life must from the time that young recruits enter military service. My research shows that, compared to whites, a greater proportion of racial and ethnic minorities serve in combat roles, as well as also serving in branches with higher levels of exposure to combat and other dangerous experiences such as exposure to chemical or environmental hazards (Sheehan et al. 2015). Placement processes should be reviewed and such differences rectified in order to eliminate racial disparities in exposure to dangerous situations that have lifelong consequences for health.

Medalists from the 33rd National Veterans Wheelchair Games (2013), from Houston, TX. (Source: U.S. Department of Veteran Affairs)
Medalists from the 33rd National Veterans Wheelchair Games (2013), from Houston, TX. (Source: U.S. Department of Veteran Affairs)

Other researchers have shown that after military service, minority veterans attain lower levels of education and economic prosperity than their white counterparts – two components that are consistently linked to worse health (Teachman and Call 1996). To counter this, the VA could expand occupational training focused specifically on underrepresented groups, with the understanding that these programs may improve health.

Beyond these measures, there are also specific health interventions that could be used as models to design approaches that can help reduce disparities. One intervention which improved the overall health among a primarily black elderly veteran sample in Washington, D.C. relied on Home Based Primary Care (HBPC). HBPC emphasized the integration between social workers, physicians, nurses, pharmacists, dentists, and dietitians in providing care at home for the elderly population (see: Chang et al. 2009). Researchers found that those who received HBPC had 43.7% fewer hospital admissions and spent almost 50% fewer days in the hospital than those who did not.

Another intervention found that racial disparities in knee surgery outcomes were reduced when veterans were well-educated about their medical options. The black veterans who received more information on their treatment options experienced significantly less pain and greater physical function than black veterans who did not receive the information. There were little differences for the white veterans (Weng et al. 2007). These experiences suggest that integrating multiple domains and focusing on education regarding the health care system and health care options could help to minimize health disparities among veterans.

Veterans have sacrificed greatly for their country. Now it is time for their country to sacrifice for them, and work to end these health disparities. If the presidential candidates are as committed to veterans as their rhetoric claims, we should soon see policies and programs aimed at improving the health of all veterans.

Acknowledgements: I thank the Population Research Center, the Population Reference Bureau (Specifically Elizabeth and Reshma for their helpful comments), Shantel for her comments. All those working at the VA to end health disparities and all the veterans who have served. Mistakes and views are my own.

 

References

Chang, C., Jackson, S. S., Bullman, T. A., & Cobbs, E. L. (2009). Impact of a home-based primary care program in an urban Veterans Affairs medical center. Journal of the American Medical Directors Association, 10(2), 133–137.

Teachman, J. D., & Call, V. R. (1996). The effect of military service on educational, occupational, and income attainment. Social Science Research,25(1), 1-31.

Sheehan, C. M., Hummer, R. A., Moore, B. L., Huyser, K. R., & Butler, J. S. (2015). Duty, Honor, Country, Disparity: Race/Ethnic Differences in Health and Disability Among Male Veterans. Population research and policy review,34(6), 785-804.

Weng, H. H., Kaplan, R. M., Boscardin, W. J., MacLean, C. H., Lee, I. Y., Chen, W., & Fitzgerald, J. D. (2007). Development of a decision aid to address racial disparities in utilization of knee replacement surgery. Arthritis Care & Research, 57(4), 568–575.


Connor Sheehan is a fifth-year doctoral student in the Department of Sociology and the Population Research Center. His research analyzes health inequality and how institutions get “under the skin” to influence our health.  Follow him on Twitter at @ConDemography